title: Effects and costs of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: The FIT@Home study.
abstract: BACKGROUND
  Physical training has beneficial effects on exercise capacity, quality of life and mortality in patients after a cardiac event or intervention and is therefore a core component of cardiac rehabilitation. However, cardiac rehabilitation uptake is low and effects tend to decrease after the initial rehabilitation period. Home-based training has the potential to increase cardiac rehabilitation uptake, and was shown to be safe and effective in improving short-term exercise capacity. Long-term effects on physical fitness and activity, however, are disappointing. Therefore, we propose a novel strategy using telemonitoring guidance based on objective training data acquired during exercise at home. In this way, we aim to improve self-management skills like self-efficacy and action planning for independent exercise and, consequently, improve long-term effectiveness with respect to physical fitness and physical activity. In addition, we aim to compare costs of this strategy with centre-based cardiac rehabilitation.
  
  
  METHODS
  This randomized controlled trial compares a 12-week telemonitoring guided home-based training program with a regular, 12-week centre-based training program of equal duration and training intensity in low to moderate risk patients entering cardiac rehabilitation after an acute coronary syndrome or cardiac intervention. The home-based group receives three supervised training sessions before they commence training with a heart rate monitor in their home environment. Participants are instructed to train at 70-85% of their maximal heart rate for 45-60 minutes, twice a week. Patients receive individual coaching by telephone once a week, based on measured heart rate data that are shared through the internet. Primary endpoints are physical fitness and physical activity, assessed at baseline, after 12 weeks and after one year. Physical fitness is expressed as peak oxygen uptake, assessed by symptom limited exercise testing with gas exchange analysis; physical activity is expressed as physical activity energy expenditure, assessed by tri-axial accelerometry and heart rate measurements. Secondary endpoints are training adherence, quality of life, patient satisfaction and cost-effectiveness.
  
  
  CONCLUSIONS
  This study will increase insight in long-term effectiveness and costs of home-based cardiac rehabilitation with telemonitoring guidance. This strategy is in line with the trend to shift non-complex healthcare services towards patients' home environments.
  
  
  BACKGROUND
  Dutch Trial Register: NTR3780. Clinicaltrials.gov register: NCT01732419.
authors.affiliation: Department of Medical Informatics, Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands. j.j.kraal@amc.uva.nl.
authors.forename: Jos J
authors.initials: JJ
authors.lastname: Kraal
authors.forename: Niels
authors.initials: N
authors.lastname: Peek
authors.forename: M Elske
authors.initials: ME
authors.lastname: van den Akker-Van Marle
authors.forename: Hareld M C
authors.initials: HM
authors.lastname: Kemps
mesh_terms: D005080:Exercise Test / Q000191:economics / Q000379:methods / Q000592:standards; D005081:Exercise Therapy / Q000191:economics* / Q000379:methods / Q000592:standards; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000191:economics* / Q000534:rehabilitation*; D006701:Home Nursing / Q000191:economics* / Q000379:methods / Q000592:standards; D006801:Humans; D010353:Patient Education as Topic / Q000191:economics* / Q000379:methods / Q000592:standards; D012307:Risk Factors; D012648:Self Care / Q000191:economics / Q000379:methods / Q000592:standards; D017216:Telemedicine / Q000191:economics* / Q000379:methods / Q000592:standards; D016896:Treatment Outcome